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        <div class="f-title">当前位置：<span class="js_index">首页</span> > <span>家庭医生服务</span> > <span>家医签约服务</span></div>
        <div class="main df">
          <div class="left">
            <p class="bg js_my_doctor df"><span class="pic icon1201"></span><span class="word">我的家医</span></p>
            <p class="js_change_an bg"><span class="pic icon1202"></span><span class="word">建档档案</span></p>
            <p class="js_change_jy bg df"><span class="pic icon1202"></span><span class="word">更换家医</span></p>
            <p class="js_jy_package bg df"><span class="pic icon1203"></span><span class="word">家医服务包</span></p>
            <div class="fw bb hide">
              <p class="base df"><span>基本服务包</span><span>></span></p>
              <p class="base df hui"><span>基本服务包</span><span>></span></p>
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            <p class="js_suggestion df bg"><span class="pic icon1204"></span><span class="word">意见和建议</span></p>
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            <div class="tit bb">您还未在广内社区卫生服务中心建档，请如实填写以下信息建档信息</div>
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            <div class="write bb cs  js_base_info ">
              <!-- <div class="w-con df bb">
                <div class="w-left bb w">
                  <p class="row bb df"><span class="t">姓名:</span><input type="text" class="bb js_input_da  js_input_name "
                      data-keyname="name" placeholder="请输入您的真实姓名" data-form="0"></p>
                  <p class="row bb df hide"><span class="t">出生日期:</span><input type="date" class="bb"
                      placeholder="2018/01/31"></p>
                  <p class="row bb df "><span class="t">签约医生：</span><input type="text" class="bb js_input_da " readonly
                      data-keyname="" placeholder="请输入签约医生姓名" data-form="0"></p>
                </div>
                <div class="w-right bb w">
                  <p class="row bb df js_avdio" data-keyname="gender" data-form='0'><span class="t">性别:</span><span class="circle bb yi js_select cb"
                      data-index="1"><i></i></span><span class="word">男</span>
                    <span class="circle bb er  js_select" data-index="2"><i class="cg"></i></span><span class="word">女</span></p>
                  <p class="row bb df"><span class="t">身份证号:</span><input type="text" class="bb js_input_da js_input_card"
                      placeholder="请输入您的身份证号" data-keyname="idcard" data-form="1"></p>
                  <p class="row bb df hide"><span class="t">建档日期:</span><input type="date" class="bb js_recorddate "
                      placeholder="2018/01/31"></p>
                </div>
              </div> -->
              <p class="tits df"><span class="icon"></span><span>基本情况</span></p>
              <div class="w-con df bb">
                <div class="w-left bb w">
                  <p class="row bb df rows"><span class="t">现住址：</span><input type="text" class="bb js_input_da js_curaddress "
                      placeholder="请输入现在居住的详细地址" data-keyname="curaddress" data-form="1"></p>
                  <p class="row bb df"><span class="t">乡镇（街道）名称：</span><input type="text" class="bb js_input_da js_addrstreetcode"
                      data-keyname="addrstreetcode" placeholder="请输入您的乡镇（街道）名称" data-form='1'></p>
                  <p class="row bb df"><span class="t">村（居）委会名称：</span><input type="text" class="bb  js_addrcommitteecode"
                      data-keyname="addrcommitteecode" placeholder="请输入您的村（居）委会名称" data-form='1'></p>
                  <p class="row bb df js_avdio js_householdtype " data-keyname="householdtype" data-form="1"><span
                      class="t">常住类型：</span><span class="circle bb yi  js_select cb" data-index='1'><i></i></span><span
                      class="word">户籍</span>
                    <span class="circle bb er js_select" data-index='2'><i class=""></i></span><span class="word">非户籍</span></p>
                  <p class="row bb df"><span class="t">户籍地址：</span><input type="text" class="bb js_input_da js_hometown "
                      data-keyname="hometown" placeholder="请输入您的户籍地址" data-form="1"></p>
                  <p class="row bb df"><span class="t">建档日期:</span><input type="text"  placeholder="2018/01/31" readonly="readonly" class=" ipticon bb js_recorddate" t_id="kui_date"></p>

                  <p class="row bb df rows"><span class="t">联系电话：</span><input type="number" class="bb js_input_da js_phonenumber"
                      maxlength="11"
                      placeholder="请输入自己手机号" data-keyname="phonenumber" data-form="1"></p>
                  <p class="row bb df js_ethnictype js_avdio" data-keyname="ethnictype" data-form='1'><span class="t">民族：</span><span
                      class="circle bb yi js_select cb" data-index="1"><i></i></span><span class="word">汉族</span>
                    <span class="circle bb er   js_select" data-index="5"><i class=""></i></span><span class="word">少数民族</span></p>
                  <div class="row bb df">
                    <p class="l t">血型：</p>
                    <div class=" s js_avdio js_rhbloodtype" data-keyname="rhbloodtype" data-form="1">
                      <p class="bb df ">
                        <span class="circle bb san  js_select" data-index='1'><i></i></span><span class="word">A型</span>
                        <span class="circle bb san  js_select" data-index='2'><i class=""></i></span><span class="word">B型</span>
                        <span class="circle bb san  js_select" data-index='3'><i class=""></i></span><span class="word">O型</span>
                        <span class="circle bb san  js_select" data-index='4'><i class=""></i></span><span class="word">AB型</span>
                      </p>
                      <p  class="bb df rh ">
                         <span class="circle bb   js_select" data-index='6'><i class=""></i></span><span class="word">RH：阴性</span>
                        <span class="circle bb si  js_select" data-index='7'><i class=""></i></span><span class="word">RH：阳性</span>
                        <span class="circle bb cb san js_select" data-index='5'><i class=""></i></span><span class="word">不详</span>
                      </p>
                      
                    </div>
                  </div>
                  <p class="row bb df"><span class="t">工作单位：</span><input type="text" class="bb js_input_da js_workunit"
                      data-keyname="workunit" placeholder="请输入您的工作单位" data-form="1"></p>
                  <p class="row bb df"><span class="t">联系人姓名：</span><input type="text" class="bb js_input_da js_contactorname"
                      data-keyname="contactorname" placeholder="请输入联系人姓名" data-form="1"></p>
                  <p class="row bb df"><span class="t">联系人电话：</span><input type="text" class="bb js_input_da js_contactorphone"
                    maxlength="11"
                      data-keyname="contactorphone" placeholder="请输入联系人电话" data-form="1"></p>
                  <div class="block danxuan bb">
                    <p class="row bb df radius"><span class="t">职业：</span></p>
                    <div class="checks bb js_professiontype js_avdio" data-keyname="professiontype" data-form="1">
                      <p class=" bb df rows c"><span class="bb  circle cb js_select" data-index='1'><i></i></span><span
                          class="t">国家机关、党群组织、企业、事业单位负责人</span>
                      </p>
                      <p class=" bb df rows c"><span class="bb circle js_select" data-index='2'><i class=""></i></span><span
                          class="t">专业技术人员</span>
                      </p>
                      <p class="bb df rows c"><span class="bb circle js_select" data-index='3'><i class=""></i></span><span
                          class="t">办事人员和有关人员</span>
                      </p>
                      <p class=" bb df rows c"><span class="bb js_select  circle " data-index='4'><i class=""></i></span><span
                          class="t">商业、服务业人员</span>
                      </p>
                      <p class=" bb df rows c"><span class="bb circle js_select" data-index='5'><i class=""></i></span><span
                          class="t">农、林、牧、渔、水利业生产人员</span>
                      </p>
                      <p class=" bb df rows c"><span class="bb circle js_select" data-index='6'><i class=""></i></span><span
                          class="t">生产、运输设备操作人员及有关人员</span>
                      </p>
                      <p class=" bb df rows c"><span class="bb circle js_select" data-index='7'><i class=""></i></span><span
                          class="t">军人</span>
                      </p>
                      <p class=" bb df rows c"><span class="bb  circle js_select" data-index='8'><i class=""></i></span><span
                          class="t">不便分类的其他从业人员</span>
                      </p>
                      <p class=" bb df rows c"><span class="bb circle js_select" data-index='9'><i class=""></i></span><span
                          class="t">其他</span>
                      </p>
                      <p class=" bb df rows c"><span class="bb circle js_select" data-index='10'><i class=""></i></span><span
                          class="t">不详</span>
                      </p>
                    </div>
                  </div>
                </div>
                <div class="w-right bb w">
                  <div class="block danxuan bb">
                    <p class=" bb df row radius"><span class="t">文化程度：</span></p>
                    <div class="checks bb js_educationlevel js_avdio" data-form="1" data-keyname="educationlevel">
                      <div class="wenhua">
                        <p class="bb df rows c"><span class="bb  circle js_select" data-index='1'><i></i></span><span
                            class="t">文盲及半文盲</span>
                        </p>
                        <p class="row bb df rows c"><span class="bb  circle js_select" data-index='2'><i class=""></i></span><span
                            class="t">小学</span>
                        </p>
                      </div>
                      <div class="wenhua">
                        <p class="row bb df rows c"><span class="bb  circle js_select" data-index='3'><i class=""></i></span><span
                            class="t">初中</span>
                        </p>
                        <p class="row bb df rows c"><span class="bb  circle js_select" data-index='4'><i class=""></i></span><span
                            class="t">高中/技校/中专</span>
                        </p>
                      </div>
                      <div class="wenhua">
                        <p class="row bb df rows c"><span class="bb  circle js_select" data-index='5'><i class=""></i></span><span
                            class="t">大学专科及以上</span>
                        </p>
                        <p class="row bb df rows c"><span class="bb  circle js_select" data-index='6'><i class=""></i></span><span
                            class="t">不详</span>
                        </p>
                       
                      </div>
                      <div class="wenhua">
                        <p class="row bb df rows c"><span class="bb  circle js_select" data-index='7'><i class=""></i></span><span
                          class="t">研究生及以上学历</span>
                      </p>
                      </div>
                      
                    </div>
                  </div>
                  <div class="block danxuan bb">

                    <p class=" bb df row  radius"><span class="t">婚姻状况：</span></p>

                    <div class="checks bb js_avdio js_maritalstatus" data-form="1" data-keyname="maritalstatus">
                      <div class="wenhua">
                        <p class="bb df rows c"><span class="bb  circle cb js_select" data-index='1'><i></i></span><span
                            class="t">未婚</span>
                        </p>
                        <p class="row bb df rows c"><span class="bb circle js_select" data-index='2'><i class=""></i></span><span
                            class="t">已婚</span>
                        </p>
                      </div>
                      <div class="wenhua">
                        <p class="row bb df rows c"><span class="bb circle js_select" data-index='3'><i class=""></i></span><span
                            class="t">丧偶</span>
                        </p>
                        <p class="row bb df rows c"><span class="bb circle js_select" data-index='4'><i class=""></i></span><span
                            class="t">离婚</span>
                        </p>
                      </div>
                      <div class="wenhua">
                        <p class="row bb df rows c"><span class="bb circle js_select" data-index='5'><i class=""></i></span><span
                            class="t">未说明的婚姻状况</span>
                        </p>

                      </div>

                    </div>
                  </div>


                  <div class="block bb">
                    <p class="row bb df  radius"><span class="t">医疗费用支付方式</span></p>
                    <div class="checks bb js_avdio js_paytype" data-form="1" data-keyname="paytype">
                      <p class="row bb df rows c"><span class="bb check checkG js_kuang bb" data-index='1'></span><span
                          class="t">城镇职工基本医疗保险</span>
                      </p>
                      <p class="row bb df rows c"><span class="bb check js_kuang bb" data-index='2'></span><span class="t">城镇居民基本医疗保险</span>
                      </p>
                      <p class="row bb df rows c"><span class="bb check js_kuang bb" data-index='3'></span><span class="t">新型农村合作医疗</span>
                      </p>
                      <p class="row bb df rows c"><span class="bb check js_kuang bb" data-index='4'></span><span class="t">贫困救助商业医疗保险</span>
                      </p>
                      <p class="row bb df rows c"><span class="bb check js_kuang bb" data-index='5'></span><span class="t">商业医疗保险医疗保险</span>
                      </p>
                      <p class="row bb df rows c"><span class="bb check js_kuang bb" data-index='6'></span><span class="t">全公费</span>
                      </p>
                      <p class="row bb df rows c"><span class="bb check js_kuang bb" data-index='7'></span><span class="t">全自费</span>
                      </p>
                      <p class="row bb df rows c"><span class="bb check js_kuang bb" data-index='8'></span><span class="t">其他</span>
                      </p>
                    </div>
                  </div>
                  <!-- <div class="block bb">
                    <p class="row bb df rows"><span class="t">医保号：</span><input type="text" class="bb js_input_da"
                        placeholder="请输入您的医保账号" data-keyname="healthCode" data-form="1"></p>

                  </div> -->

                </div>
              </div>
              <div class="mbtn"><span class="btn js_jlda_next">下一页</span></div>
            </div>
            <!-- 健康情况 -->
            <div class="health bb  cs  js_heath_info hide ">
              <p class="tits title df"><span class="icon"></span><span>健康情况</span></p>
              <div class="heal bb df">
                <div class="heal-left heal-com">
                  <div class="block bb">
                    <p class="h-first bb border-b">体检</p>
                    <p class="h-second bb border-b df"><span class="h-w h-w1">身高：</span><input type="number"
                        placeholder="请输入您的身高" class="h-w h-w3 bb js_input_da js_indicatorList" data-keyname="indicatorList"
                        data-form="2" data-type="1" /><span class="h-w h-w2">cm</span></p>
                    <p class="h-second bb border-b df"><span class="h-w h-w1">体重：</span><input type="number"
                        placeholder="请输入您的体重" class="h-w h-w3 bb js_input_da js_indicatorList" data-keyname="indicatorList"
                        data-form="2" data-type="2"><span class="h-w h-w2">kg</span></p>
                    <p class="h-second bb border-b df"><span class="h-w h-w1">腰围：</span><input type="number"
                        placeholder="请输入您的腰围" class="h-w h-w3 js_input_da js_indicatorList" data-keyname="indicatorList"
                        data-form="2" data-type='3'><span class="h-w h-w2">cm</span></p>
                    <p class="h-second bb border-b df"><span class="h-w h-w1">臀围：</span><input type="number"
                        placeholder="请输入您的臀围" class="h-w h-w3 js_input_da js_indicatorList" data-keyname="indicatorList"
                        data-form="2" data-type='4'><span class="h-w h-w2">cm</span></p>
                    <p class="h-second bb border-b df"><span class="h-w h-w1">收缩压：</span><input type="number"
                        placeholder="请输入您的收缩压（高压）" class="h-w h-w3 js_input_da js_indicatorList" data-keyname="indicatorList"
                        data-form="2" data-type='5'><span class="h-w h-w2">mmHg</span></p>
                    <p class="h-second bb border-b nob df"><span class="h-w h-w1 ">舒张压：</span><input type="number"
                        placeholder="请输入您的舒张压（低压）" class="h-w h-w3 js_input_da js_indicatorList" data-keyname="indicatorList"
                        data-form="2" data-type='6'><span class="h-w h-w2">mmHg</span></p>
                  </div>
                  <div class="block bb">
                    <p class="h-first  bb border-b">既往史</p>
                    <div class="sblock bb">
                      <div class='contain js_needhide js_historyDisease'>
                        <div class="bb  df s-p js_avdio " data-keyname="historyDisease" data-form="2">
                          <p class="s-word  df s-word1">疾病史</p>
                          <p class="df s-word2 "><span class="circle cb bb js_select" data-index='2' data-noselect='1'
                              data-keyword='historyList' data-illname='0'><i></i></span><span class="s-word">无</span></p>
                          <p class="df s-word2 "><span class="circle bb js_select" data-index='1' data-keyword='historyList'
                              data-illname='0'><i></i></span><span class="s-word">有</span></p>
                        </div>
                        <div class="duoxuan dfsb js_tohide hide">
                          <p class="eat df ">
                            <span class="box js_kuang bb js_jw bb" data-index='2'></span>
                            <span class="s-word">高血压</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb js_jw bb" data-index='3'></span>
                            <span class="s-word">糖尿病</span>
                          </p>
                          <p class="eat df">
                            <span class="box js_kuang bb js_jw bb" data-index='4'></span>
                            <span class="s-word">冠心病</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb js_jw bb" data-index='6'></span>
                            <span class="s-word">恶性肿瘤</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb js_jw bb" data-index='7'></span>
                            <span class="s-word">脑卒中</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb js_jw bb" data-index='8'></span>
                            <span class="s-word">严重精神障碍</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb js_jw bb" data-index='9'></span>
                            <span class="s-word">结核病</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb js_jw bb" data-index='10'></span>
                            <span class="s-word">肝炎</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb js_jw bb" data-index='12'></span>
                            <span class="s-word">职业病</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb js_jw bb" data-index='11'></span>
                            <span class="s-word">其他法定传染病</span>
                          </p>
                          <p class="eat df  ">
                            <span class="box js_kuang bb js_jw bb" data-index='13'></span>
                            <span class="s-word">其他</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb js_jw bb" data-index='5'></span>
                            <span class="s-word">慢性阻塞性肺疾病</span>
                          </p>

                        </div>
                      </div>
                      <div class="shoushu  border-b avdio js_needhide js_historyDisease">
                        <div class="bb df s-p js_avdio " data-keyname="historyDisease" data-form="2">
                          <p class="s-word  df s-word1">手术</p>
                          <p class="df s-word2 "><span class="circle cb bb js_select" data-index='0' data-noselect='1'
                              data-keyword='historyList' data-illname='1'><i></i></span><span class="s-word">无</span></p>
                          <p class="df s-word2 "><span class="circle bb js_select" data-index='1' data-keyword='historyList'
                              data-illname='1'><i></i></span><span class="s-word">有</span></p>

                        </div>
                        <div class="miaosu df js_tohide hide js_date">
                          <input type="text" data-index='1' placeholder="输入手术并选择日期"
                            class="js_d" />
                            <input type="text" placeholder="2018/01/31"
                            data-index='1' readonly="readonly" class=" ipticon bb js_birthday" t_id="kui_date">
                        </div>
                      </div>
                      
                      <div class="shoushu  border-b avdio js_needhide js_historyDisease">
                        <div class="bb  df s-p js_avdio avdio js_historyDisease" data-keyname="historyDisease"
                          data-form="2">
                          <p class="s-word  df s-word1">外伤</p>
                          <p class="df s-word2 "><span class="circle cb bb js_select" data-index='0' data-noselect='1'
                              data-keyword='historyList' data-illname='2'><i></i></span><span class="s-word">无</span></p>
                          <p class="df s-word2 "><span class="circle bb js_select" data-index='1' data-keyword='historyList'
                              data-illname='2'><i></i></span><span class="s-word">有</span></p>
                        </div>
                        <div class="miaosu df js_tohide hide js_date">
                          <input type="text" data-index='2' placeholder="输入外伤并选择日期"
                            class="js_d" />
                            <input type="text"  placeholder="2018/01/31"
                            data-index='2'
                            readonly="readonly" class=" ipticon bb js_birthday" t_id="kui_date">
                          </div>
                      </div>
                      <div class="shoushu  avdio js_needhide js_historyDisease">
                        <div class="bb  df s-p js_avdio " data-keyname="historyDisease" data-form="2">
                          <p class="s-word  df s-word1">输血</p>
                          <p class="df s-word2 "><span class="circle cb bb js_select" data-index='0' data-noselect='1'
                              data-keyword='historyList' data-illname='3'><i></i></span><span class="s-word">无</span></p>
                          <p class="df s-word2 "><span class="circle bb js_select" data-index='1' data-keyword='historyList'
                              data-illname='3'><i></i></span><span class="s-word">有</span></p>
                        </div>
                        <div class="miaosu df js_tohide hide js_date">
                          <input type="text" data-index='3' placeholder="输入输血量并选择日期"
                            class="js_d" />
                            <input type="text" placeholder="2018/01/31"
                            data-index='3'
                            readonly="readonly" class=" ipticon bb js_birthday" t_id="kui_date">
                        </div>
                      </div>
                    </div>
                  </div>
                  <div class="block bb">
                    <p class="h-first  bb border-b">遗传病史</p>
                    <div class="sblock bb">
                      <div class='contain js_needhide'>
                        <div class="bb  df s-p border-b js_avdio js_fhfather" data-keyname="" data-form="2">
                          <p class="s-word  df s-word1">父亲</p>
                          <p class="df s-word2 "><span class="circle cb bb js_select" data-index='2' data-noselect='1'
                              data-keyword="yichuanshi" data-illname="fhfather"><i></i></span><span class="s-word">无</span></p>
                          <p class="df s-word2 "><span class="circle bb js_select" data-index='1' data-keyword="yichuanshi"
                              data-illname="fhfather"><i></i></span><span class="s-word">有</span></p>
                        </div>
                        <div class="duoxuan dfsb js_tohide hide js_yc js_fhfatherdes" data-name="fhfatherdes">
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='2'></span>
                            <span class="s-word">高血压</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='3'></span>
                            <span class="s-word">糖尿病</span>
                          </p>
                          <p class="eat df">
                            <span class="box js_kuang bb" data-index='4'></span>
                            <span class="s-word">冠心病</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb " data-index='5'></span>
                            <span class="s-word">慢性阻塞性肺疾病</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='6'></span>
                            <span class="s-word">恶性肿瘤</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='7'></span>
                            <span class="s-word">脑卒中</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='8'></span>
                            <span class="s-word">严重精神障碍</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='9'></span>
                            <span class="s-word">结核病</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='10'></span>
                            <span class="s-word">肝炎</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='11'></span>
                            <span class="s-word">先天畸形</span>
                          </p>

                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='12'></span>
                            <span class="s-word">其他</span>
                          </p>

                        </div>
                      </div>
                      <div class='contain js_needhide'>
                        <div class="bb  df s-p border-b js_avdio js_fhmother" data-keyname="" data-form="2">
                          <p class="s-word  df s-word1">母亲</p>
                          <p class="df s-word2 "><span class="circle cb bb js_select" data-index='2' data-noselect='1'
                              data-keyword="fhmother" data-illname="fhfather"><i></i></span><span class="s-word">无</span></p>
                          <p class="df s-word2 "><span class="circle bb js_select" data-index='1' data-keyword="yichuanshi"
                              data-illname="fhmother"><i></i></span><span class="s-word">有</span></p>
                        </div>
                        <div class="duoxuan hide dfsb js_tohide js_yc js_fhmotherdes" data-name="fhmotherdes">
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='2'></span>
                            <span class="s-word">高血压</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='3'></span>
                            <span class="s-word">糖尿病</span>
                          </p>
                          <p class="eat df">
                            <span class="box js_kuang bb" data-index='4'></span>
                            <span class="s-word">冠心病</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='5'></span>
                            <span class="s-word">慢性阻塞性肺疾病</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='6'></span>
                            <span class="s-word">恶性肿瘤</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='7'></span>
                            <span class="s-word">脑卒中</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='8'></span>
                            <span class="s-word">严重精神障碍</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='9'></span>
                            <span class="s-word">结核病</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='10'></span>
                            <span class="s-word">肝炎</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='11'></span>
                            <span class="s-word">先天畸形</span>
                          </p>

                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='12'></span>
                            <span class="s-word">其他</span>
                          </p>

                        </div>
                      </div>

                      <div class='contain js_needhide '>
                        <div class="bb  df s-p border-b js_avdio js_fhbrother" data-keyname="" data-form="2">
                          <p class="s-word  df s-word1">兄弟姐妹</p>
                          <p class="df s-word2 "><span class="circle cb bb js_select" data-index='2' data-noselect='1'
                              data-keyword="yichuanshi" data-illname="fhbrother"><i></i></span><span class="s-word">无</span></p>
                          <p class="df s-word2 "><span class="circle bb js_select" data-index='1' data-keyword="yichuanshi"
                              data-illname="fhbrother"><i></i></span><span class="s-word">有</span></p>
                        </div>
                        <div class="duoxuan js_tohide dfsb hide js_yc js_fhbrotherdes" data-name="fhbrotherdes">
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='2'></span>
                            <span class="s-word">高血压</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='3'></span>
                            <span class="s-word">糖尿病</span>
                          </p>
                          <p class="eat df">
                            <span class="box js_kuang bb" data-index='4'></span>
                            <span class="s-word">冠心病</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='5'></span>
                            <span class="s-word">慢性阻塞性肺疾病</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='6'></span>
                            <span class="s-word">恶性肿瘤</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='7'></span>
                            <span class="s-word">脑卒中</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='8'></span>
                            <span class="s-word">严重精神障碍</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='9'></span>
                            <span class="s-word">结核病</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='10'></span>
                            <span class="s-word">肝炎</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='11'></span>
                            <span class="s-word">先天畸形</span>
                          </p>

                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='13'></span>
                            <span class="s-word">其他</span>
                          </p>

                        </div>
                      </div>
                      <div class='contain js_needhide js_fhchildren'>
                        <div class="bb  df s-p  js_avdio" data-keyname="historyDisease" data-form="2">
                          <p class="s-word  df s-word1">子女</p>
                          <p class="df s-word2 "><span class="circle cb bb js_select" data-index='1' data-noselect='1'
                              data-keyword="yichuanshi" data-illname="fhchildren"><i></i></span><span class="s-word">无</span></p>
                          <p class="df s-word2 "><span class="circle bb js_select" data-index='2' data-keyword="yichuanshi"
                              data-illname="fhchildren"><i></i></span><span class="s-word">有</span></p>
                        </div>
                        <div class="duoxuan hide dfsb js_tohide js_yc fhchildrendes" data-name="fhchildrendes">
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='2'></span>
                            <span class="s-word">高血压</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='3'></span>
                            <span class="s-word">糖尿病</span>
                          </p>
                          <p class="eat df">
                            <span class="box js_kuang bb" data-index='4'></span>
                            <span class="s-word">冠心病</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='5'></span>
                            <span class="s-word">慢性阻塞性肺疾病</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='6'></span>
                            <span class="s-word">恶性肿瘤</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='7'></span>
                            <span class="s-word">脑卒中</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='8'></span>
                            <span class="s-word">严重精神障碍</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='9'></span>
                            <span class="s-word">结核病</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='10'></span>
                            <span class="s-word">肝炎</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='11'></span>
                            <span class="s-word">先天畸形</span>
                          </p>
                          <p class="eat df ">
                            <span class="box js_kuang bb" data-index='12'></span>
                            <span class="s-word">其他</span>
                          </p>

                        </div>
                      </div>

                    </div>
                  </div>
                  <div class="block bb">
                    <p class="h-first bb border-b">药物过敏史</p>
                    <div class="sblock bb js_ywguomin js_allergyhistory" data-keyname="allergyHistory" data-form="2">
                      <p class="bb border-b df eat"><span class="box checkG js_kuang bb " data-index='1' data-noselect="1"></span><span
                          class="s-word">无</span></p>
                      <p class="bb border-b df eat"><span class="box js_kuang bb" data-index='2'></span><span class="s-word">青霉素</span></p>
                      <p class="bb border-b df eat"><span class="box js_kuang bb" data-index='3'></span><span class="s-word">磺胺</span></p>
                      <p class="bb border-b df eat"><span class="box js_kuang bb" data-index='4'></span><span class="s-word">链霉素</span></p>
                      <p class="bb border-b df nob h-second eat"><span class="box js_kuang bb" data-index='5'></span><span
                          class="s-word">其他</span><input type="text" placeholder="请输入您过敏药物的名称" class="h-w hide h-w3 js_guomin_input"
                          data-keyname="allergyName" data-form="2"></p>
                    </div>
                  </div>
                  <div class="block bb">
                    <p class="h-first bb border-b">暴露史</p>
                    <div class="h-second eat  abox df bb js_baolu" data-keyname="exposureHistory" data-form="2">
                      <p class="bao df"><span class="box checkG js_kuang bb" data-index='1'></span><span class="s-word">无</span></p>
                      <p class="bao df"><span class="box js_kuang bb" data-index='2'></span><span class="s-word">化学品</span></p>
                      <p class="bao df"><span class="box js_kuang bb" data-index='3'></span><span class="s-word">毒物</span></p>
                      <p class="bao df"><span class="box js_kuang bb" data-index='4'></span><span class="s-word">射线</span></p>
                    </div>
                  </div>
                  <div class="block bb js_needhide js_disability">
                    <div class="bb df s-p border-b  js_avdio" data-keyname="disability" data-form="2">
                      <p class="s-word  df s-word1 bing">残疾情况</p>
                      <p class="df s-word2"><span class="circle cb bb js_select" data-index='2' data-noselect='1'><i></i></span><span
                          class="s-word">无</span></p>
                      <p class="df s-word2"><span class="circle bb js_select" data-index='1'><i></i></span><span class="s-word">有</span></p>
                    </div>
                    <div class="duoxuan dfsb jibing js_tohide hide js_yc" data-name="disabilitydescription">
                      <p class="eat df ">
                        <span class="box js_kuang bb" data-index='1'></span>
                        <span class="s-word">视力残疾</span>
                      </p>
                      <p class="eat df ">
                        <span class="box js_kuang bb" data-index='2'></span>
                        <span class="s-word">听力残疾</span>
                      </p>
                      <p class="eat df">
                        <span class="box js_kuang bb" data-index='3'></span>
                        <span class="s-word">言语残疾</span>
                      </p>
                      <p class="eat df ">
                        <span class="box js_kuang bb" data-index='4'></span>
                        <span class="s-word">肢体残疾</span>
                      </p>
                      <p class="eat df ">
                        <span class="box js_kuang bb" data-index='5'></span>
                        <span class="s-word">智力残疾</span>
                      </p>
                      <p class="eat df">
                        <span class="box js_kuang bb" data-index='6'></span>
                        <span class="s-word">精神残疾</span>
                      </p>
                      <p class="eat df">
                        <span class="box js_kuang bb" data-index='7'></span>
                        <span class="s-word">其他残疾</span>
                      </p>
                    </div>
                  </div>

                </div>
                <div class="heal-right heal-com">

                  <div class="block bb js_needhide js_smsmoking">
                    <div class="bb df s-p js_avdio" data-form="2" data-keyname="smsmoking">
                      <p class="s-word  df s-word1 bing">吸烟史</p>
                      <p class="df s-word2"><span class="circle cb bb js_select" data-index='2' data-noselect='1'><i></i></span><span
                          class="s-word">无</span></p>
                      <p class="df s-word2"><span class="circle bb js_select" data-index='1'><i></i></span><span class="s-word">有</span></p>
                      <p class="df s-word2"><span class="circle  bb js_select" data-index='3'><i></i></span><span class="s-word">已戒</span></p>
                    </div>
                    <div class="xiyan js_tohide hide">
                      <div class="row df border-b">
                        <span class="s-word1">开始吸烟时间：</span>
                        <input type="text" placeholder="2018/01/31"
                        readonly="readonly" class=" ipticon bb js_smock_start" t_id="kui_date">
                      </div>
                      <div class="row df border-b">
                        <span class="s-word1">吸烟量：</span>
                        <select name="" id="" class="js_select_options">
                          <option value='0'>请选择</option>
                          <option value="1">偶尔： < 3支/周 </option> <option value="2">少量： 1-4支/日</option>
                          <option value="3">经常： ≥5支/日</option>
                        </select>
                      </div>
                      <div class="row df hide">
                        <span class="s-word1">烟龄：</span>
                        <input type="number" class="bb js_smock_age " placeholder="请输入">
                      </div>
                    </div>

                  </div>
                  <div class="block bb js_needhide js_dkdrinking">
                    <div class="bb df s-p js_avdio" data-form="2" data-keyname="dkdrinking">
                      <p class="s-word  df s-word1 bing">饮酒史</p>
                      <p class="df s-word2"><span class="circle cb bb js_select" data-index='2' data-noselect='1'><i></i></span><span
                          class="s-word">无</span></p>
                      <p class="df s-word2"><span class="circle bb js_select" data-index='1'><i></i></span><span class="s-word">有</span></p>
                      <p class="df s-word2"><span class="circle  bb js_select" data-index='3'><i></i></span><span class="s-word">已戒</span></p>
                    </div>
                    <div class="xiyan js_tohide hide">
                      <div class="row df border-b">
                        <span class="s-word1">饮酒类型：</span>
                        <select name="" id="" class="js_dirink_dktype">
                          <option value='0'>请选择</option>
                          <option value="1">色酒（酒精含量< 15）</option> <option value="2">啤酒（酒精含量15-40）</option>
                          <option value="3">白酒（酒精含量≥45）</option>

                        </select>
                      </div>
                      <div class="row df border-b">
                        <span class="s-word1">饮酒量：</span>
                        <select name="" id="" class='js_dirink_dkamount'>
                          <option value='0'>请选择</option>
                          <option value="1">少量： 啤酒 < 250-50ml/次，色酒100-150ml/次 </option> <option value="2">中量： 啤酒 <
                                500-2500ml/次，色酒100-150ml/次 </option> <option value="3">大量： 啤酒 > 2500ml/次，其它酒>250ml/次</option>
                        </select>
                      </div>
                      <div class="row df">
                        <span class="s-word1">饮酒频率：</span>
                        <select name="" id="" class="bb js_dirink_dkrate">
                          <option value='0'>请选择</option>
                          <option value="1">偶尔（每年< 3-4次）</option> <option value="2">少量（每周< 3次） </option> <option value="3">经常（每天喝）</option>

                        </select>
                      </div>
                      <div class="row df">
                        <span class="s-word1">戒酒日期：</span>
                        <input type="text"  placeholder="2018/01/31" readonly="readonly" class=" ipticon bb js_dirink_dkend" t_id="kui_date">
                      </div>
                    </div>

                  </div>
                  <div class="block bb js_needhide js_exexercise">
                    <div class="bb df s-p js_avdio" data-form="2" data-keyname="exexercise">
                      <p class="s-word  df s-word1 bing">体育锻炼</p>
                      <p class="df s-word2"><span class="circle cb bb js_select" data-index='2' data-noselect='1'><i></i></span><span
                          class="s-word">无</span></p>
                      <p class="df s-word2"><span class="circle bb js_select" data-index='1'><i></i></span><span class="s-word">有</span></p>
                      <p class="df s-word2"><span class="circle  bb js_select" data-index='3'><i></i></span><span class="s-word">无规律</span></p>
                    </div>
                    <div class="xiyan js_tohide hide">
                      <div class="row df border-b">
                        <span class="s-word1">锻炼情况：</span>
                        <select name="" id="" class="js_excycle">
                          <option value='0'>请选择</option>
                          <option value="1">每天锻炼</option>
                          <option value="2">每周1-2次</option>
                          <option value="3">每周3次及以上</option>

                        </select>
                      </div>
                      <div class="row df border-b">
                        <span class="s-word1">每次锻炼时间：</span>
                        <select name="" id="" class="js_extime">
                          <option value='0'>请选择</option>
                          <option value="1">< 30分钟</option>
                             <option value="2">30-60分钟
                          </option>

                          <option value="3">1小时以上</option>

                        </select>
                      </div>
                      <div class="row df">
                        <span class="s-word1">锻炼类型</span>
                        <select name="" id="" class="bb js_extype">
                          <option value='0'>请选择</option>
                          <option value="1">有氧运动（慢跑、气功、极拳、跳舞、散步、游泳、登山等）</option>
                          <option value="2">无氧运动（速跑、篮球、排球、足球等剧烈运动） </option>
                          <option value="3">其他</option>

                        </select>
                      </div>
                    </div>

                  </div>

                  <div class="block bb">
                    <p class="h-first bb border-b">饮食习惯</p>
                    <div class="sblock bb avdio js_yc js_diet" data-name="fhtype" data-form="2">
                      <p class="bb border-b df eat"><span class="box checkG js_kuang bb" data-index='1'></span><span
                          class="s-word">荤素均匀</span></p>
                      <p class="bb border-b df eat"><span class="box js_kuang bb" data-index='2'></span><span class="s-word">荤食为主</span></p>
                      <p class="bb border-b df eat"><span class="box js_kuang bb" data-index='3'></span><span class="s-word">素食为主</span></p>
                      <p class="bb border-b df eat"><span class="box js_kuang bb" data-index='4'></span><span class="s-word">嗜盐</span></p>
                      <p class="bb border-b df eat"><span class="box js_kuang bb" data-index='5'></span><span class="s-word">嗜酒</span></p>
                      <p class="bb border-b df eat"><span class="box js_kuang bb" data-index='6'></span><span class="s-word">嗜糖</span></p>
                      <p class="bb h-second df eat"><span class="h-w">摄盐量:</span><input type="number" placeholder="请输入您的饮食克数"
                          class="h-w h-w3 js_yinshl" data-form='2' data-keyname="dietNumber"><span class="h-w h-w2 ">克/次</span></p>
                      <!-- <div class="bb border-b df nob s-p js_avdio js_salt" data-keyname="salt" data-form='2'>
                        <p class="s-word  df s-word1">摄盐情况</p>
                        <p class="df s-word2"><span class="circle cb bb js_select" data-index="1"><i></i></span><span
                            class="s-word">适中</span></p>
                        <p class="df s-word2"><span class="circle bb js_select" data-index="2"><i></i></span><span
                            class="s-word">偏咸</span></p>
                        <p class="df s-word2"><span class="circle bb js_select" data-index="3"><i></i></span><span
                            class="s-word">偏咸</span></p>
                      </div> -->
                    </div>
                  </div>
                  <div class="block bb">
                    <p class="h-first bb border-b">睡眠情况</p>
                    <div class="sblock js_needhide js_sltime">
                      <p class="bb h-second   border-b df eat"><span class="h-w">睡眠量：</span><input type="number"
                          placeholder="请输入您的睡眠时间" class="h-w h-w3 js_shuimianl" data-form="2" data-keyname="sleepNumber"><span
                          class="h-w h-w2 ">小时/天</span></p>
                      <div class="bb border-b  df nob s-p js_avdio " data-form="2" data-keyname="slsituation">
                        <p class="s-word  df s-word1">睡眠障碍：</p>
                        <p class="df s-word2"><span class="circle cb bb js_select" data-index='2' data-noselect='1'><i></i></span><span
                            class="s-word">无</span></p>
                        <p class="df s-word2"><span class="circle bb js_select" data-index='1'><i></i></span><span
                            class="s-word">有</span></p>
                      </div>
                      <div class="duoxuan dfsb jibing hide js_tohide js_yc" data-name="sldescription">
                        <p class="eat df ">
                          <span class="box js_kuang bb" data-index='1'></span>
                          <span class="s-word">睡眠困难</span>
                        </p>
                        <p class="eat df ">
                          <span class="box js_kuang bb" data-index='2'></span>
                          <span class="s-word">入睡困难</span>
                        </p>
                        <p class="eat df">
                          <span class="box js_kuang bb" data-index='3'></span>
                          <span class="s-word">早醒</span>
                        </p>
                        <p class="eat df ">
                          <span class="box js_kuang bb" data-index='4'></span>
                          <span class="s-word">梦游</span>
                        </p>
                        <p class="eat df">
                          <span class="box js_kuang bb" data-index='5'></span>
                          <span class="s-word">其他</span>
                        </p>
                        <p class="eat df ">
                          <span class="box js_kuang bb" data-index='6'></span>
                          <span class="s-word">嗜睡</span>
                        </p>

                      </div>

                    </div>

                  </div>
                  <div class="block bb">
                    <p class="h-first bb border-b">生活环境</p >
                    <div class="bb live js_new-live ">
                      <div class="live-row">
                        <div class="live-first">厨房排风设施</div>
                        <div class="live-second js_leairexhaust" >
                          <p class="js_live" data-index='1'  data-keyword='leairexhaust'><span class="bb colorCircle"><i></i></span>无</p >
                          <p class="js_live" data-index='2' data-keyword='leairexhaust'><span class="bb"><i></i></span>油烟机</p >
                          <p class="js_live" data-index='3' data-keyword='leairexhaust'><span class="bb"><i></i></span>换气扇</p >
                          <p class="js_live" data-index='4' data-keyword='leairexhaust'><span class="bb"><i></i></span>烟囱</p >
                        </div>
                      </div>
                    </div>
                    <div class="bb live">
                      <div class="live-row">
                        <p class="live-first">燃料类型</p >
                        <div class="live-second js_lefuel">
                          <p class="js_live" data-index='1'  data-keyword="lefuel" ><span class="bb colorCircle"><i></i></span>液化气</p >
                          <p class="js_live" data-index='2' data-keyword="lefuel" ><span class="bb"><i></i></span>煤</p >
                          <p class="js_live" data-index='3' data-keyword="lefuel" ><span class="bb"><i></i></span>天然气</p >
                          <p class="js_live" data-index='4' data-keyword="lefuel" ><span class="bb"><i></i></span>天然气</p >
                          <p class="js_live" data-index='5' data-keyword="lefuel" ><span class="bb"><i></i></span>柴火</p >
                          <p class="js_live" data-index='6' data-keyword="lefuel" ><span class="bb"><i></i></span>其他</p >
                        </div>
                      </div>
                    </div>
                    <div class="bb live">
                      <div class="live-row">
                        <p class="live-first">饮水</p >
                        <div class="live-second js_lewater">
                          <p class="js_live" data-index='1' data-keyword="lewater"><span class="bb colorCircle"><i></i></span>自来水</p >
                          <p class="js_live" data-index='2' data-keyword="lewater"><span class="bb"><i></i></span>净化过滤的水</p >
                          <p class="js_live" data-index='3' data-keyword="lewater"><span class="bb"><i></i></span>井水</p >
                          <p class="js_live" data-index='4' data-keyword="lewater"><span class="bb"><i></i></span>河湖水</p >
                          <p class="js_live" data-index='5' data-keyword="lewater"><span class="bb"><i></i></span>塘水</p >
                          <p class="js_live" data-index='6' data-keyword="lewater"><span class="bb"><i></i></span>其他</p >
                        </div>
                      </div>
                    </div>
                    <div class="bb live">
                      <div class="live-row">
                        <p class="live-first">厕所</p >
                        <div class="live-second js_lewc">
                          <p class="js_live" data-index='1' data-keyword="lewc" ><span class="bb colorCircle"><i></i></span>卫生厕所</p >
                          <p class="js_live" data-index='2' data-keyword="lewc" ><span class="bb"><i></i></span>粪池</p >
                          <p class="js_live" data-index='3' data-keyword="lewc"  ><span class="bb"><i></i></span>露天粪坑</p >
                          <p class="js_live" data-index='4' data-keyword="lewc" ><span class="bb"><i></i></span>马桶</p >
                          <p class="js_live" data-index='5' data-keyword="lewc" ><span class="bb"><i></i></span>简易棚厕</p >
                        </div>
                      </div>
                    </div>
                    <div class="bb live">
                      <div class="live-row noborder">
                        <p class="live-first">禽畜栏</p >
                        <div class="live-second js_lelivestock">
                          <p class="js_live" data-index='1' data-keyword="lelivestock" ><span class="bb colorCircle"><i></i></span>无</p >
                          <p class="js_live" data-index='2' data-keyword="lelivestock"><span class="bb"><i></i></span>单设</p >
                          <p class="js_live" data-index='3' data-keyword="lelivestock"><span class="bb"><i></i></span>室内</p >
                          <p class="js_live" data-index='4' data-keyword="lelivestock"><span class="bb"><i></i></span>室外</p >
                        </div>
                      </div>
                    </div>
                  </div>
                </div>
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      <ul>
        <li>北京市西城区卫生健康委员会 </li>
        <li class="c9">Xicheng District Health Commission of Beijing Municipality</li>
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    <div class='qy_info_wrap df dfm'>
      <div class="qy_info df dfm">
        <span class="img img1">

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        <span>
          签约医生：
        </span>
      </div>
      <span class="js_qy_name">
        王医生
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    <div class='qy_info_wrap df dfm'>
      <div class="qy_info df dfm">
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        <span>
          所属机构：
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      <span class="js_qy_jg">
        新街口社区卫生服务中心
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    <div class="qy_info_wrap df dfm">
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        <span>
          签约人：
        </span>
      </div>
      <span clas="js_user_name">
        张三
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    <div class="df dfc que_ren dfm">
      <span class='pr'></span>我已认真阅读签约协议并同意签约
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      <div class="fw_cont">
        <p>1）健康状况早了解：</p>
        <p class="l2">建立健康档案，并进行健康评价，每年对慢性病患者进行1次健康状况评估，并根据评估结果，量体制订个性化的健康规划。</p>
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        <p class="l2">根据居民不同健康状况和需求，以慢性病患者为首要服务对象，提供主动健康咨询和分类指导服务。</p>
        <p>4）贴心服务我上门</p>
        <p class="l2">对空巢、行动不便并有需求的老年慢性病患者提供上门健康咨询和指导服务。</p>
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